Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies

BACKGROUND: Limited health care budgets have raised the issue of how much therapy should be dedicated to critically ill patients with multiorgan and acute renal failure (ARF). No data are available on patients with ARF after hospital discharge. METHODS: We assessed long-term survival and quality of life after discharge. Nine hundred seventy-nine patients with ARF who needed continuous renal replacement therapies were analyzed retrospectively. Contact was achieved by questionnaires assessing health status and mental and physical well-being. RESULTS: The in-hospital mortality rate was 69% (n = 678). Postdischarge information was obtained from 89% (n = 267). Kaplan-Meier analyses showed surprisingly good postdischarge survival. Discharged patients had a 77% probability to survive the first 6 months. Those who did so had a probability of 89% to survive the following 6 months. After 5 years, the survival probability was 50%. Age and more than one comorbidity before hospitalization were associated with significantly lower postdischarge survival. Seventy-seven percent of questionnaire responders assessed their current health status as good to excellent, 57% were self-sustaining, and 49% stated that their quality of life had improved. Renal insufficiency remained in 41%, whereas 10% required chronic dialysis therapy. CONCLUSION: ARF is associated with a high in-hospital mortality rate. Nevertheless, patients leaving the hospital had a reasonable survival rate and good quality of life. We conclude that aggressive intensive care unit treatment is justified in these patients.